Open AccessJournal Article
Pathophysiology of delirium
Tajana Zah Bogović,Dinko Tonković,Ante Sekulić,Ante Sekulić,Daniela Bandić-Pavlović,Daniela Bandić-Pavlović,Robert Baronica,Robert Baronica,Marko Bogović,Marko Bogović,Sanja Sakan,Sanja Sakan,Ina Filipović Grčić,Ina Filipović Grčić,Boris Tomašević,Boris Tomašević +15 more
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TLDR
Postoperative cognitive changes are more common in older than in younger patients, and they can be categorized as postoperative delirium, postoperative cognitive dysfunction and dementia, and the mechanisms responsible are not fully understood, but it is certain that they are multifactorial.Abstract:
Today's understanding of the pathophysiological mechanisms of delirium is still limited, but there are several promising hypotheses. It is believed that biomarkers sensitive to death of neurons or glial cells indicate delirium. Several neurotransmitters are considered to be involved in the state of delirium, with greatest emphasis on acetylcholine and dopamine acting in opposite ways; acetylcholine reduces, while dopamine increases neuron excitability. Other neurotransmitters that probably play a role in the pathogenesis of delirium are GABA, glutamate and monoamines. Sepsis leading to systemic inflammatory response syndrome often presents with delirium and perhaps is the most common causal factor for delirium in intensive care unit; sedatives and analgesics are also common iatrogenic risk factors. Patients receiving benzodiazepines are more likely to have postoperative delirium than those who do not. Postoperative cognitive changes are more common in older than in younger patients, and they can be categorized as postoperative delirium, postoperative cognitive dysfunction and dementia. The mechanisms responsible for postoperative cognitive changes are not fully understood, but it is certain that they are multifactorial. Risk factors may be associated with patient characteristics, type of surgery and type of anesthesia.read more
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Journal ArticleDOI
Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure.
TL;DR: Delirium is the most common neuropsychiatric syndrome encountered by clinicians dealing with older adults and the medically ill and is best characterized by 5 core domains: cognitive deficits, attentional deficits, circadian rhythm dysregulation, emotional Dysregulation, and alteration in psychomotor functioning.
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Prevalence and risk factors for development of delirium in burn intensive care unit patients.
Vivek Agarwal,Patrick J. O'Neill,Bryan A. Cotton,Brenda T. Pun,Starre Haney,Jennifer L. Thompson,Nicholas J. Kassebaum,Ayumi Shintani,Jeffrey Guy,E. Wesley Ely,Pratik P. Pandharipande +10 more
TL;DR: In conclusion, delirium occurred at least once in approximately 80% of ventilated burn patients, and exposure to benzodiazepines was an independent risk factor forDelirium, whereas opiates and methadone reduced the risk of developing delirity, possibly through reduction of pain in these patients.
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Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients
Stuart McGrane,Timothy D. Girard,Timothy D. Girard,Jennifer L. Thompson,Ayumi Shintani,Alison Woodworth,E. Wesley Ely,E. Wesley Ely,Pratik P. Pandharipande,Pratik P. Pandharipande +9 more
TL;DR: In this pilot study, high baseline inflammatory biomarkers predicted prolonged periods of acute brain dysfunction in ventilated patients, implicating inflammation as an important mechanism in the pathophysiology of delirium and coma during critical illness, irrespective of whether patients had sepsis or not.
Journal ArticleDOI
State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018
Elizabeth Mahanna-Gabrielli,Katie J. Schenning,Lars Eriksson,Jeffrey N. Browndyke,Clinton B. Wright,Lis Evered,David Scott,Nae Yah Wang,Charles H. Brown,Esther S. Oh,Patrick L. Purdon,Sharon K. Inouye,Miles Berger,Robert A. Whittington,Stacie Deiner +14 more
TL;DR: The state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders are summarized.
Journal ArticleDOI
Delirium in the intensive care unit: a review.
TL;DR: Multicomponent interventions to prevent delirium, developed in the non-ICU setting, can be adapted to critically ill patients with the purpose of reducing its incidence and target interventions should be evaluated to preventDelirium in the ICU.
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